J. Scott Applewhite, Associated Press
WASHINGTON — House Republicans resurrected the specter of Medicare rationing Thursday in an election-year vote to repeal cost controls in President Barack Obama's health care overhaul.
In the GOP crosshairs is a board that has yet to be named but would be empowered to force cuts to drug companies, insurers and other service providers if Medicare spending balloons. A Republican plan announced this week, laying down a dividing line between the parties, also would limit Medicare cost increases, but it would rely on competition among private insurance plans.
GOP lawmakers are hoping their symbolic 223-181 vote on Thursday to repeal the Independent Payment Advisory Board will help persuade seniors that Republicans, not Democrats, are the best stewards of Medicare.
The bill is likely to hit a dead end in the Senate. House Republicans all but guaranteed that when they paired the board repeal with caps on medical malpractice awards, which most Democrats oppose. The White House has issued a veto threat.
If it all sounds like a debate among Washington insiders, Rep. Jack Kingston, R-Ga., says he will have no trouble explaining to constituents why he voted to repeal the cost-cutting board.
"Do you remember death panels?" said Kingston, referring to the debunked accusation by former GOP vice presidential candidate Sarah Palin that Obama's health care law would allow the government to withhold life-saving care from the elderly.
"It's not necessarily a death panel, but it is a rationing panel and rationing does lead to scarcity for some," he added. "Who's going to get the needed treatment, an 85-year-old or the 40-year-old with children?"
The health care law explicitly bars the board from rationing care, shifting costs to Medicare recipients or cutting their benefits. But critics say squeezing service providers will stifle medical innovation, achieving a similar result.
Many House Democrats also oppose the board — dubbed IPAB for its initials — but for different reasons. They feel it diminishes the role of Congress. But Republicans made it difficult to attract Democratic votes for repeal by adding other politically charged provisions to their bill.
"Republicans don't want to see IPAB repealed now because they want to run against it," said Scott Gottlieb, a former senior FDA official in the George W. Bush administration. "I think there will be an effort to repeal it after the election."
The House vote came a day before the second anniversary of the health care law, and just ahead of next week's Supreme Court deliberations on its constitutionality. Politics aside, the vote highlighted major differences between the parties on Medicare, the giant health care program for nearly 50 million seniors and disabled people.
All sides agree that Medicare as currently structured will not be able to pay its bills in the long run. The main options to control costs are unpalatable: tax increases, benefit cuts and cost shifts to middle- and upper-income retirees.
Most Republicans and Democrats also agree now that there has to be a limit on future Medicare increases. The question is how.
Republicans would convert Medicare into a system dominated by private health insurance plans closely regulated by the government. Future retirees would get a fixed payment to buy either private coverage or sign up for a new government plan modeled on traditional Medicare. The plan counts on competition among the plans to help keep costs in check, but the annual government payment would also be limited by tying it to economic growth.
That's the basic approach embodied in the new budget released this week by Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee, and seconded by GOP presidential candidate Mitt Romney.
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